Provider Demographics
NPI:1518184100
Name:ALBERTINI, SUSAN (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ALBERTINI
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-4605
Mailing Address - Country:US
Mailing Address - Phone:954-981-9785
Mailing Address - Fax:
Practice Address - Street 1:12600 PEMBROKE ROAD
Practice Address - Street 2:SUITE # 206
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-435-6211
Practice Address - Fax:954-435-6212
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9103454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant